Individual
CARLOS BOLIVAR PANCHANA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
D ST #3089, KAILUA, HI 96734
(321) 890-7187
Mailing address
10345 HOLDER WAY, SAN DIEGO, CA 92124-2512
(321) 890-7187
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
CA
Other
Enumeration date
02/10/2020
Last updated
02/10/2020
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